Provider Demographics
NPI:1578828083
Name:RECOVERY ROAD CHARITABLE NON PROFIT ORGANIZATION
Entity Type:Organization
Organization Name:RECOVERY ROAD CHARITABLE NON PROFIT ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-792-4173
Mailing Address - Street 1:2666 SEYMOUR DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49344-9523
Mailing Address - Country:US
Mailing Address - Phone:269-792-4173
Mailing Address - Fax:269-792-4173
Practice Address - Street 1:961 ALPINE AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4451
Practice Address - Country:US
Practice Address - Phone:616-915-0594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty